TLIF?

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michael
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May 12, 2012 at 5:36 am

Post count: 7

#6185

Dr. Corenman

I have been dealing with DDD at L4/L5 and L5/S1 for well over a year now. I have low central back pain right about where L5/S1 disc is and I have sciatica in both legs. Most of the leg pain is in my feet but I do get some pain in the tighs and buttocks as well. The sciatica pain in both legs is 90% of the time when I sit and the remaining 10% of the time it’s when I stand or lie down (standing and lying down are completely tolerable) Sitting is the issue. I am an airline pilot and sitting is my lively hood and career. I have had and MRI, 6 weeks of PT, and 3 rounds of steriod shots at the L4/L5 and L5/S1 levels. The shots gave some relief but only for about a week or so at a time.

When I sit, it is NOT instant sciatica. It’s gradually comes on after about 5-10 minutes and then becomes gradually more uncomfortable. Soemtimes it’s tolerable and soemtimes it’s unbearable. It is affecting my job and I need to get this resolved if at all posslbe.

I had an MRI and it shows disc dengeration at L4/L5 and L5/S1. There is no herniation. L4/L5 has a small posterior central bulge. It doesn’t appear to be touching the nerves (but I understand that the MRI is taken while lying down, so sitting that may be different?) What is the success rate with the TLIF, at least, in your exprience? Have you ever worked on any pilots? I would love to get this issue solved as I sit for 5-9 hours a day without the ability to get up and move around to get relief. I would be willing to travel to you for diagnosis if you are able to accept a new patient. I have seen a couple of nuerosurgeons in the Houston area, but just don’t feel too comfortable with them.

Any info is greatly appreciated. Thank you.

texasspondy
Member

May 13, 2012 at 12:23 am

Post count: 25

#6188

Maybe Doctor Corenman will give us an airline discount, ha. Kidding aside, I also am in the Houston area, and have conversed over the forum that is with Dr Corenman. Also in the airline biz, however, I don’t fly them, I maintain them.
Anyrate, I have found a neuorsurgeon in the area that I felt comfortable with his knowledge, experience, patience, and bedside manners. However, I am very impressed with the website literature that Dr. Corenman has here, including explanations, video’s, pictures, and the time he takes to respond to questions that the general public has on back problems.

It is my intention to follow up as to what procedures, one would have to go through being an “out of towner”, to see Dr. Corenman and possibly have a TLIF performed on me as well. From what I see, Dr. Corenman will suffiice very well as my second opinion and depending on cost/circumstances, might be the primary surgeon.

Not to hijack your thread, just wanted to chime in, was interested in your decision.

Donald Corenman, MD, DC
Moderator

May 13, 2012 at 2:58 am

Post count: 8660

#6189

You note your pain is both lower back pain and leg pain (sciatica). You have minimal to no leg pain while standing but develop leg pain when sitting. The pain occurrence with sitting is gradual and intensity changes intermittently. Your MRI notes DDD of L4-5 and L5-S1.

Some questions. What is the percentage of back vs. leg pain? It seems to change with standing vs. sitting. Would you say that you have 80% lower back pain and 20% leg pain with standing but the percentage changes with sitting? When you sit, does the leg pain always start in your feet and radiate up or does it start in your buttocks and radiate down?

There are some potential different diagnoses for your leg pain. Your back pain is most likely from your degenerative disc disease. If you have a condition called isolated disc resorption (see website) where the disc cushion has completely worn away, as a pilot you are more susceptible to vibration generated by the plane and this will increase your back pain.

The leg pain can occur from spinal nerve irritation but if your MRI notes no significant nerve compression (including lateral recess stenosis which can be missed on some MRIs), the foot pain can be generated by peripheral nerve entrapment. Leg nerves run in tunnels just like the median nerve of the hand runs in the carpel tunnel. This entrapment is also somewhat common with pilots. An EMG/NCV test can help to diagnose nerve entrapment.

By the way, yes I very much like pilots and do take care of many fixed and roto-wing pilots. I am a pseudo-pilot myself (need 10 more hours and better cross-wind landings).

Dr. Corenman

PLEASE REMEMBER, THIS FORUM IS MEANT TO PROVIDE GENERAL INFORMATION ON SPINE ANATOMY, CONDITIONS AND TREATMENTS. TO GET AN ACCURATE DIAGNOSIS, YOU MUST VISIT A QUALIFIED PROFESSIONAL IN PERSON.

Donald Corenman, MD, DC is a highly-regarded spine surgeon, considered an expert in the area of neck and back pain. Trained as both a Medical Doctor and Doctor of Chiropractic, Dr. Corenman earned academic appointments as Clinical Assistant Professor and Assistant Professor of Orthopaedic Surgery at the University of Colorado Health Sciences Center, and his research on spine surgery and rehabilitation has resulted in the publication of multiple peer-reviewed articles and two books.

michael
Member

May 13, 2012 at 8:09 am

Post count: 7

#6192

Dr. Corenman,

The percentage of back to leg pain varies. It’s usually more leg pain than back pain. I’d say 70% leg to 30% back pain. And lying down or standing/walking always relieves most of it. If I’m bent over working on my classic cars the back pain gets pretty bad as well. I don’t really work on my cars anymore because of it.

The leg pain is almost always in my feet first (burning, tingling, stinging sensations…like the sensation you get in your arm/hand when a blood pressure cuff is inflated). After sitting for a bit I will start to get mostly aching type pains in my outer/back thighs, side and back of buttocks. Mostly in the left leg, but some in the right as well. (some of these sensations are like hot/cold feelings)

My back pain is usually centralized right in the middle where the L5/S1 disc would be. I know this because of where the needle tracks are from my steroid shots. Can a TLIF be utilized for a two level fusion? And what is the procedure for the nerve entrapment you mentioned?

I’m more than willing to travel to see you as you have explained more than any other doctor I have seen. I forgot to mention that I’m 39 years old. Go get those your last ten hours of flight time and get your pilots certificate! I learned up in the mountains of Colorado in Rangely. Mountain flying experience is invaluable.

Michael

Donald Corenman, MD, DC
Moderator

May 13, 2012 at 10:44 pm

Post count: 8660

#6194

The back pain you experience is most likely from the degenerative disc disease. A two level TLIF is a common procedure and most patients do well. There are limitations with a two level TLIF however. Impact sports and activities (running, tennis, heavy lifting and some other need to be avoided. You are replacing pain for stiffness in the spine.

The problem is that pain relief after surgery is generally good so some patients forget their restrictions. They go back to all the activities they have avoided due to pain and can then stress the disc above. The genetics of the annulus (brittle collagen- see website under DDD) do not change and these patients have an increased chance of tearing the disc above. As long as you can be satisfied with pain relief and only some increased activity, then a two level TLIF is a good choice.

Your leg pain needs to be worked up. Ask your current physician if they would consider ordering an EMG/NCV test by a neurologist. This might note the source of your foot pain, especially if you do have peripheral nerve entrapment.

By the way, mountain flying is just plain fun.

Dr. Corenman

PLEASE REMEMBER, THIS FORUM IS MEANT TO PROVIDE GENERAL INFORMATION ON SPINE ANATOMY, CONDITIONS AND TREATMENTS. TO GET AN ACCURATE DIAGNOSIS, YOU MUST VISIT A QUALIFIED PROFESSIONAL IN PERSON.

Donald Corenman, MD, DC is a highly-regarded spine surgeon, considered an expert in the area of neck and back pain. Trained as both a Medical Doctor and Doctor of Chiropractic, Dr. Corenman earned academic appointments as Clinical Assistant Professor and Assistant Professor of Orthopaedic Surgery at the University of Colorado Health Sciences Center, and his research on spine surgery and rehabilitation has resulted in the publication of multiple peer-reviewed articles and two books.

dustingfab
Member

May 14, 2012 at 6:26 am

Post count: 27

#6196

Thanks for the clear explanation Dr. Corenman. So a fusion regardless of location of the spine replaces pain for stiffness. And with stiffness, a person would need to change their lifestyle and level activity.
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Donald Corenman, MD, DC

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81 reviews

Eric S

Sep 26, 2021

by Eric S on Donald Corenman, MD, DC

Successful pars repair at 46 years old

Back in November of 2018 (at 46 years old) I came from Vancouver BC to have a pars repair done with Dr. Donald Corenman at the Steadman Clinic in Vail Colorado. I'm finally posting this review nearly three years later in late 2021. The reason I waited so long was I wanted to know the final result before I posted my review. Unfortunately in that time Dr. Corenman has retired. Nevertheless, I want to post this review of Dr. Corenman and his staff at the Steadman Clinic in their excellent treatment of my L5 pars interarticularis.

I fractured my pars at age 42 back in 2014 when rolling on the gym floor, and was denied treatment by the Canadian healthcare system, probably due to my age. First my GP told me there was no surgical option for a pars defect, which was quite incorrect! I tried to live with it, but the symptoms worsened (periodic random spine slippage and weeks of resultant pain after just bending over to tie my shoe, so I eventually learned to mostly squat and hardly bend). When I finally consulted with Canadian spine surgeons, I was told they believed my pars defect had been congenital (since birth). This was absurd, considering I had done extreme martial arts (including jiu jitsu) for years prior, as well as 5 years of reinforcing steel full time in my 20s, probably the hardest job on the back you can find. No pars defect like mine would possibly have allowed this--ergo it was impossible that I had had the defect since birth. I did however have an asymptomatic congenital spina bifida occulta that made me more susceptible to a pars fracture. In 2014 in one instant, I went from having the strongest back people I knew said they'd ever seen, to being unable to safely bend over and tie my shoe without a non-negligible risk of my spine slipping randomly (which would lead to weeks of pain after each occurrence). This was due to the unilateral L5 pars defect, otherwise known as spondylolysis. It was when lying in pain on the floor 4 years later after maybe the 6th spine slippage event post injury, that I had had enough, and resolved to have surgery. If Canada's "universal health care" said no, I would make lemonade from lemons, and find the very best surgeon in the world at pars repairs. That was Dr. Donald Corenman. Dr. Corenman back in 2018 ran a website https://neckandback.com/ that dedicated many pages to the science of every aspect of pars repairs, from eligibility (good discs on MRI), to best surgical techniques (minimal open compared to minimally invasive), best imaging to use (i.e., O-Arm with Stealth imaging vs. older fluoroscopy), the ideal amount of BMP to use and why not use too much or too little, and much more, all to do with pars repairs, pages upon pages of his site just on the pars, with scientific references and his own extensive expert opinion. As a health research statistician, I was very impressed with this. It was in stark contrast to the websites of other spine surgeons which barely gave the pars a word or two, focusing almost exclusively on fusions. I had found the best surgeon in the world for pars repairs, and so after Dr. Corenman personally screened my MRI to ensure my discs were healthy, I booked the surgery.

Being 46 years old at the time of surgery in 2018, with a 4-year-old pars fracture from 2014 combined with a congenital SBO meant my pars fragment was somewhat atrophied, but it was "very solid", said Dr. Corenman in the operative report. Nevertheless, it was challenging with two things to fix, the pars and SBO, and OR time was around 4 hours. Recovery over the following months was guided by a very clear "Spine binder" from the Steadman Clinic with strict rules of "no BLT" (no bending, lifting or twisting), and illustrated physiotherapy guidelines. They even warned patients to avoid fish oil supplements, which could excessively dampen inflammation and hence slow bone healing. They answered many questions I had during months of recovery, with responses coming from the very supportive Lori Fugate (then director of Dr. Corenman's practice), and Ehrich Bean (then physician's assistant at the practice), as well as a couple calls with Dr. Corenman himself after two of the CT scans. Ehrich Bean offered great advice for taking the spine binder conservatively due to the nature of pars repairs vs. fusions. The final post-op CT scan I had was a couple weeks ago at 34 months post-op, and Dr. Corenman had retired, but I got a very positive and informative call from Eric Strauch (current PA at the Steadman Clinic under Dr. Corenman's replacement there, and who had also worked with Dr. Corenman previously). The staff at the Steadman Clinic were extremely supportive all the way through the process. I should mention, the local Canadian spine surgeon did offer me very good post-operative support including antibiotics as needed to deal with a mild surface incision-site infection early on, booking numerous x-rays when I felt something was amiss, as well as booking all four of my post-op CT scans. I am very grateful for that support also.

My final result shows plenty of solid bone across the pars and a healed SBO, with my vertebral body now a solid bone ring instead of being broken at two places as it was pre-op. Does my spine hold up in the real world? You bet! I have recently dug and moved several yards of dirt and sand and gravel by myself (shovel and wheelbarrow!) to fix our water main, pulled roots from the yard, moved several "portable" (these are HUGE) air conditioners up several flights of stairs my myself, and lifted weights. I now run 2 miles (3.2 KM) several times weekly with a hard 100 meter dash in the middle. I bend deeply before each run I go on, with no spine slippage. My spine feels amazing. I can bend over to do exercise, or real word tasks, with no risk of spine slippage.

My sincere thanks to God, Dr. Donald Corenman, Lori Fugate, Ehrich Bean, Eric Strauch, and the Steadman Clinic, as well as the Canadian spine surgeon who offered me excellent post-operative care back in Canada. You have all given me a new lease on life.

Sincerely,
Eric S

Robert S

May 11, 2021

by Robert S on Donald Corenman, MD, DC

Back Fusion Surgery

I had my entire lumbar spine fused in November of 2018. I had scoliosis , with pinched nerves that were so painful I could hardly walk - and standing for more than a few minutes was impossible. Even sitting was painful.
The fusion surgery produced immediate relief! And the recovery was much easier than I expected.
To this day I can do all the activities I love from hiking, to standing in a stream fly fishing to riding my bike long distances - or just walking down the street with my wife.
Kudos to Dr. Corenman and his staff, (including the two Erics) for taking such good care of me!

Leslie R

Jul 9, 2020

by Leslie R on Donald Corenman, MD, DC

TLIF

I had my TLIF surgery on 6/24/2020 by Dr. Corenman, I can not say enough good things about the Dr or his staff. I was always treated with respect and explained everything throughly, that made it easy for everyone to understand. I highly recommend Dr. Corenman and the Steadman Clinic.

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